Hmong Promoting Vaccines Website: A Pilot Feasibility eHealth Study to Promote Adolescent Human Papilloma Virus Vaccinations (Preprint)

Abstract

Human papillomavirus (HPV) is a common sexually transmitted infection (STI), causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished through HPV vaccination. Unfortunately, vaccination rates among Hmong-Americans are substantially lower than other racial/ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally-appropriate educational intervention to improve Hmong-American s’ HPV vaccine rates.

To develop and evaluate the effectiveness and usability of an innovative interactive eHealth educational website, called Hmong Promoting Vaccines Website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations.

Through social cognitive theory and community-based participatory action research (CBPAR) process, we created a theory-driven, culturally- and linguistically-appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website’s effectiveness and usability. Thirty Hmong-American parent/adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at pre-intervention, one-week post-intervention, and five-week follow-up. Participants responded to survey questions about website content and processes at one and five weeks, and a subset of 20 dyad participants participated in telephone interviews six weeks later. We used paired t-tests to measure the change in knowledge, self-efficacy, and decision-making processes and used template analysis to identify a priori themes for website usability.

Participants’ HPV and HPV vaccine knowledge improved significantly from pre- to post-intervention and follow-up. Knowledge scores increased from pre-intervention to one- week post-intervention for both parents (HPV knowledge P=0.01; vaccine knowledge P = 0.01) and children (HPV knowledge P=0.01; vaccine knowledge P < 0.001), which were sustained at five-week follow-up. Parents’ average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post-intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers’ self-efficacy scores (from 30.3 at baseline to 35.6 (P=.009) at post-intervention and 35.9 (P=.006) at follow-up. Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=0.024). The interview data also revealed that the website’s content was informative and engaging; particularly, participants enjoyed the interactive quizzes and vaccine reminders.

This theory-driven, CBPAR designed, and culturally and linguistically-appropriate educational website was well-received. It improved Hmong parents’ and adolescents’ knowledge, self-efficacy, and decision-making processes about HPV vaccines. Future studies should examine the website’s impact on HPV vaccine uptake and its potential for broader utilization across various settings (e.g., clinics, schools).